Objective To observe the clinical characteristics of demyelinating optic neuritis (DON) in Chinese children under the age of 16. Methods A retrospective review of the medical charts of 42 pediatric patients with DON was conducted in this study. Twenty-two patients (52.4%) were male, and 20 patients (47.6%) were female. The patients aged from 3 to 15 years, with the mean age of (9.5±2.3) years. There were 35 bilateral patients and 7 unilateral patients. Twenty-seven patients (64.3%) had prodromal symptoms before onset. All patients underwent visual function and imaging tests, such as best corrected visual acuity (BCVA), fundus photography, visual evoked potential (VEP), visual field, MRI. The patients were tested for serum levels of antibodies for aquaporin 4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) with a cell-based assay. All patients were received corticosteroid therapy. The mean follow-up was (1.17±0.42) years. The children who had coordination ability and with BCVA≥0.3 were received examination of Humphery automatic perimeter. Data were collected on the age, gender, clinical features, neuroimaging, serological specific antibodies, treatment and vision prognosis. Results 23.8% of the children were bilateral optic neuritis in onset stages. 64.2% were recurrent optic neuritis and 83.3% exhibited bilateral diseases eventually. BCVA had decreased to ≤0.1 in 87.0%% eyes and disc swelling was observed in 77.9% eyes during the onset stages. All eyes had visual field defects and abnormal VEP exam results, with delayed latency of P100 and P2, and varying degrees of amplitude reduction. Serum AQP4 antibody and MOG antibody were tested by cell-based assay, 2/42 children (4.7%) were positive for AQP4 antibody and 5/24 children (20.8%) were positive for MOG antibody. All of anti-AQP4+ and anti- MOG+ cases relapsed. All children underwent orbital magnetic resonance imaging (MRI), 40 cases (95.2%) showed demyelination features of optic nerve, and 5 cases (11.9%) showed long segments lesion (more than 1/2 length of the optic nerve). There were 2 anti-AQP4+ cases and 3 anti- MOG+ cases from the 5 cases with long segments lesion. MRI also showed brain demyelinating lesions in 4 children (3 of them were anti- MOG+) or spinal cord demyelinating lesions in 3 children (2 of them were anti- MOG+). After treatment with glucocorticoid, visual acuity improved in all eyes, of which 84.4% with BCVA≥0.5. Forty-eight eyes of 26 children accept dynamic visual field during the course of treatment, showed the vision abnormalities associated with optic nerve damage. Conclusions Children under the age of 16 with DON can experience severe visual impairment, higher recurrence tendencies, and higher rate of disc involvement, but good response to glucocorticoid therapy. AQP4 or MOG antibodies positive might be concurrent with brain and (or) spinal cord demyelinating lesions and indicated a poorer prognosis.
Extraction and analysis of electroencephalogram (EEG) signal characteristics of patients with autism spectrum disorder (ASD) is of great significance for the diagnosis and treatment of the disease. Based on recurrence quantitative analysis (RQA)method, this study explored the differences in the nonlinear characteristics of EEG signals between ASD children and children with typical development (TD). In the experiment, RQA method was used to extract nonlinear features such as recurrence rate (RR), determinism (DET) and length of average diagonal line (LADL) of EEG signals in different brain regions of subjects, and support vector machine was combined to classify children with ASD and TD. The research results show that for the whole brain area (including parietal lobe, frontal lobe, occipital lobe and temporal lobe), when the three feature combinations of RR, DET and LADL are selected, the maximum classification accuracy rate is 84%, the sensitivity is 76%, the specificity is 92%, and the corresponding area under the curve (AUC) value is 0.875. For parietal lobe and frontal lobe (including parietal lobe, frontal lobe), when the three features of RR, DET and LADL are combined, the maximum classification accuracy rate is 82%, the sensitivity is 72%, and the specificity is 92%, which corresponds to an AUC value of 0.781. The research in this paper shows that the nonlinear characteristics of EEG signals extracted based on RQA method can become an objective indicator to distinguish children with ASD and TD, and combined with machine learning methods, the method can provide auxiliary evaluation indicators for clinical diagnosis. At the same time, the difference in the nonlinear characteristics of EEG signals between ASD children and TD children is statistically significant in the parietal-frontal lobe. This study analyzes the clinical characteristics of children with ASD based on the functions of the brain regions, and provides help for future diagnosis and treatment.
ObjectiveTo investigate the effect of ambroxol hydrochloride on c-Jun N-terminal kinase (JNK) signal pathway in gastric aspiration lung injury. MethodsForty healthy male Sprague Dawley rats were randomly divided into a control group, an injury group, a SP600125 (JNK specific inhibitor) group and an ambroxol group. The model of gastric aspiration lung injury was established by aspiration of gastric contents. The rats in the SP600125 group preoperatively received intravenous injection of JNK specific inhibitor SP600125 (3 mg/100 g). The rats in the ambroxol group received intravenous injection of ambroxol hydrochloride (50 mg/kg) 2 hours after the damage occurred. The neutrophil count and malondialdehyde (MDA) activity in bronchoalveolar lavage fluid (BALF), the lung wet weight/dry weight ratio (W/D), and myeloperoxidase (MPO) activity were measured. The protein expressions of JNK and phosphorylated JNK (p-JNK) and inducible nitric oxide synthase (iNOS) in lung tissue were detected by Western blot method. The changes of lung tissue structure were observed under light microscope. ResultsIn the injury group, the neutrophil counts and MDA activity in BALF, W/D, MPO activity, p-JNK and iNOS protein expression increased significantly, lung tissue appeared obvious histopathological injury compared with the control group. In the SP600125 group and the ambroxol group, neutrophil count and MDA activity in BALF, lung W/D, MPO activity, p-JNK and iNOS protein expression were significantly decreased compared with the injury group (P < 0.05), and the damage of the lung tissue pathology was reduced. The expression of JNK protein in lung tissue was not different in all groups (P > 0.05). ConclusionsJNK is involved in inflammatory reaction of gastric aspiration lung injury. The protective effect of ambroxol may be related to the inhibition of JNK signaling pathway and the inhibition of iNOS expression.
ObjectiveTo evaluate the effectiveness of cemented polyethylene liner technique in hip revision.MethodsBased on inclusion criteria, the clinical data of 26 patients who were undergone hip revision between January 2011 and December 2013, were retrospectively reviewed. Among them, 14 cases were treated with isolated liner exchange (group A) and 12 cases were treated with cemented polyethylene liner technique (group B). There was no significant difference in gender, age, the time from primary total hip arthroplasty to revision, and the preoperative Harris score between 2 groups (P>0.05). The post-operative Harris score and complications were compared between 2 groups, and X-ray findings of the hip joint were recorded to review the position of hip components.ResultsAll patients were followed up 4.4-6.4 years (mean, 5.4 years). Except for two femoral fractures during the revision (1 in each group), there was no other complication in 2 groups. The hip pain relieved and the lame gait corrected in 2 groups. The hip’s function of 2 groups improved gradually after operation, with a better Harris score at 3 months and the best at last follow-up, compared with preoperative scores (P<0.05). There was no significant difference in Harris score at difference time points after operation between 2 group (P>0.05). X-ray films showed no dislocation, aseptic loosening, and other interface related complication.ConclusionFor the cases without the chance to do change liner, cemented polyethylene liner technique has a good effectiveness. But restrict patient selection should be considered before hip revision.
The early diagnosis of children with autism spectrum disorders (ASD) is essential. Electroencephalography (EEG) is one of most commonly used neuroimaging techniques as the most accessible and informative method. In this study, approximate entropy (ApEn), sample entropy (SaEn), permutation entropy (PeEn) and wavelet entropy (WaEn) were extracted from EEGs of ASD child and a control group, and Student's t-test was used to analyze between-group differences. Support vector machine (SVM) algorithm was utilized to build classification models for each entropy measure derived from different regions. Permutation test was applied in search for optimize subset of features, with which the SVM model achieved best performance. The results showed that the complexity of EEGs in children with autism was lower than that of the normal control group. Among all four entropies, WaEn got a better classification performance than others. Classification results vary in different regions, and the frontal lobe showed the best performance. After feature selection, six features were filtered out and the accuracy rate was increased to 84.55%, which can be convincing for assisting early diagnosis of autism.
In order to eliminate the influence of motion artifacts, high-frequency noise and baseline drift on photoplethysmographic (PPG), and to obtain the accurate value of heart rate in motion state, this paper proposed a de-noising method of PPG signal based on normalized least mean square (NLMS) adaptive filtering combining ensemble empirical mode decomposition(EEMD). Firstly, the PPG signal containing noise is passed through an adaptive filter with a 3-axis acceleration sensor as a reference signal to filter out motion artifacts. Secondly, the PPG signal is decomposed by EEMD to obtain a series of intrinsic modal function (IMF) according to the frequency from high to low. The threshold range of the signal is judged by the permutation entropy (PE) criterion, thereby filtering out the high frequency noise and the baseline drift. The experimental results show that the Pearson correlation coefficient between the calculated heart rate of PPG signal and the standard heart rate based on electrocardiogram (ECG) signal is 0.731 and the average absolute error percentage is 6.10% under different motion states, which indicates that the method can accurately calculate the heart rate in moving state and is beneficial to the physiological monitoring under the state of human motion.
ObjectiveTo investigate the risk factors affecting the 28-day neurological outcome after admission of patients with sepsis complicated with consciousness disorder, create a simple scoring system, and evaluate its predictive value for the poor neurological outcome.MethodsWe retrospectively collected and analyzed the demographic data, clinical data, 28-day survival status and neurologic outcome of patients with sepsis complicated with disturbance of consciousness admitted to the Emergency Department of West China Hospital of Sichuan University between June 1st, 2017 and May 31st, 2018. Independent risk factors for the 28-day neurologic outcome of patients with disturbance of consciousness were obtained through univariate analyses and multiple logistic regression analysis, and then the continuous variables of risk factors were converted to binary variables according to the cut-off values from receiver operating characteristic (ROC) curve analysis, a simple scoring system was established and it’s predictive value for 28-day neurological outcome of patients with sepsis complicated with consciousness disorder was assessed.ResultsA total of 149 patients with sepsis complicated with consciousness disorder were included in this study, including 103 males (69.1%) and 46 females (30.9%), with an average age of (58.2±18.6) years old. There were 72 patients (48.3%) with poor outcome of neurological function on Day 28 after admission. Multiple logistic regression analysis revealed that total bile acid [odds ratio (OR)=1.040, 95% confidence interval (CI) (1.004, 1.077), P=0.027], blood ammonia [OR=1.014, 95%CI (1.001, 1.027), P=0.030], pulmonary infection [OR=3.255, 95%CI (1.401, 7.566), P=0.006], and Glasgow Coma Score (GCS) [OR=0.837, 95%CI (0.739, 0.949), P=0.005] were independent influencing factors for the poor neurological function in patients with sepsis complicated with consciousness disorder on Day 28 after admission. The area under the ROC curve predicting the 28-day poor neurological function was 0.754 [95%CI (0.676, 0.832)], and the sensitivity and specificity were 79.2% and 63.6%, respectively.ConclusionFor emergency patients with sepsis complicated with consciousness disorder, a simple scoring system based on early GCS, pulmonary infection, serum ammonia, and total bile acid has a favorable predictive value for short-term neurological function.